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An open dialogue between primary care physicians and COPD patients can make a real difference.
Physicians who have honest, forthright conversations with chronic obstructive pulmonary disease (COPD) patients and take the time to explain how the disease affects them can improve their patients’ quality of life.
To facilitate discussions between providers and COPD patients in the exam room, the National Heart, Lung, and Blood Institute recommends that physicians ask patients age 40 and older about potential COPD risk factors and talk with symptomatic patients to learn more about a history of smoking, environmental or occupational exposure to irritants or genetic factors.
Once the disease has been diagnosed, primary care physicians need to explain the symptoms of COPD and how to use medications, and in what order, Bill Clark, senior director of patient outreach at COPD Foundation, told Medical Economics.
“The primary care physician needs to tell the patient that the disease is not going away, even though the symptoms may be transient. When I was diagnosed with COPD 16 years ago, I chalked up my symptoms to being out of shape. My physician told me this was a real, very concerning medical problem,” said Clark.
The physician also needs to explain the disease is progressive, and some patients progress faster than others. “The physician can emphasize that if a patient is proactive in the early stages of the disease, it will be easier to deal with later stages of the disease,” said Clark.
Visual proof of disease helps some patients become proactive, for example, offering a comparison of a normal chest X-ray to the COPD patient’s X-ray. Clark suggests physicians also provide basic spirometry data that divulges a patient’s lung age. “When someone who is 40 hears the physician say ‘Your lung age is someone who is 90,’ that can have a big impact,” he said.
In addition, COPD patients need time and space to deal with the diagnosis, and the physician needs to understand the grieving process and support the patient through it, said Clark.
One of the most critical things physicians can tell patients is that they have a voice in health management. “A patient who is more educated about the disease will be able to predict an exacerbation and treat it sooner,” said Clark. He also suggested that physicians encourage COPD patients to join a community to interact with other patients, such as the COPD Foundation’s COPD360social.
Referral to a pulmonologist is recommended for the latest treatments, and also to emphasize the seriousness of the disease, he said. Primary care physicians need to continue to work with the COPD patient to handle comorbidities, and be proactive when, for example, they note depression by offering the patient counseling, medication or lifestyle changes.
In every patient encounter, the physician needs to ask the COPD patient about cigarette smoking, said Joel Africk, president and chief executive officer of the Respiratory Health Association (RHA). “At RHA, we favor including tobacco questions in vitals, not a patient’s health history. A patient who quit five years ago may be feeling pressure at work and has started smoking again. If the patient has relapsed, remind him or her that it takes, on average, seven to 10 times before a smoker quits for good,” said Africk.
After diagnosis, for COPD patients who smoke, Clark suggests scheduling a follow-up appointment specifically to discuss quitting options, which may include referral to a tobacco hotline, health department resource or website with quit tips.